Background and Objective: Antibiotic residues from urban and industrial wastewater discharge and agricultural runoff are continuously released into freshwater environments, turning them into reservoirs that contribute to increased antibiotic resistance. Therefore, understanding the effects of antibiotic residues on aquatic organisms, especially cyanobacteria, is essential due to their vital role as primary producers in ecosystems. Materials and Methods: In this review article, over 200 reputable publications related to the effects of antibiotics on major biological processes in cyanobacteria-including photosynthesis, oxidative stress, and macromolecule metabolism-are examined in detail. The mechanisms of their adaptation to antibiotic exposure are also thoroughly reviewed. To this end, searches were conducted in databases such as Science Direct, Scopus, Web of Sciences, and open-access journal lists, using keywords like "cyanobacteria, " "biodegradation and bioremediation, " "bioaccumulation and biomagnification, " "activation of antioxidant systems, " "mechanism of action of a wide range of antibiotics, " synergistic and antagonistic effects, " "acquisition and transfer of antibiotic resistance genes, " and "mutations induced by antibiotics. " Results: The antibiotic resistance developed in microalgae is associated with an increased rate of photosynthesis, antioxidant activity, and toxin production, while oxidative stress and growth decrease. Therefore, the higher presence of cyanotoxin biomass, especially near wastewater treatment plant outlets, may play an important role in the removal of antibiotic resistance genes. Conclusion: There is a direct correlation between the levels of antibiotics and the increased production of microalgal toxins, indicating that microalgae become resistant to antibiotics over time and thus can play a vital role in eliminating the excess ROS generated from antibiotic exposure.